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目的采用流式细胞技术检测新辅助化学治疗(简称化疗)子宫颈癌后不同时间肿瘤细胞周期分布状态,探讨放射治疗的最佳时机。方法选择2013年1月至2014年5月贵阳医学院附属肿瘤医院Ⅱb期~Ⅲb期病理明确诊断为宫颈癌患者90例,中位年龄51岁。治疗方案为新辅助化疗+同步放化疗。新辅助化疗为TP方案(紫杉醇+顺铂或紫杉醇+洛铂化疗)2周期;同步化疗采用顺铂或洛铂单药;放射治疗采用盆腔调强放射治疗(IMRT)及三维适形近距离治疗。分别收集治疗前、2周期化疗后、同期放化疗前5 d、开始同期放化疗、开始同期放化疗期间每5 d取材1次、同期放化疗结束、同期放化疗结束后10 d、同期放化疗结束后30 d时DNA倍体分析。DNA倍体分析采用BD FACSCantoⅡ流式细胞仪分析。结果 2周期新辅助化疗后处于高S期细胞所占比率与新辅助化疗前相比较明显升高,分别为42.0%和60.3%(P=0.028),差异有统计学意义(P<0.05)。2周期新辅助化疗后10~15 d处于高S期细胞所占比率渐下降,与新辅助化疗前相接近(P=0.119),差异无统计学意义。放射治疗至30.6 Gy时S期细胞所占比率与新辅助化疗前相比较略有下降,放射治疗结束后处于高S期细胞所占比率进一步下降,明显低于新辅助化疗前(P=0.009)。结论子宫颈癌新辅助化疗后肿瘤细胞再分布的存在提示放射治疗最好在新辅助化疗后10~15 d开始。通过DNA倍体分析了解细胞周期,有助于指导放射治疗时间,从而增加放射治疗疗效。
Objective To detect the distribution of tumor cell cycle in different time after neoadjuvant chemotherapy (referred to as chemotherapy) for cervical cancer by flow cytometry and discuss the best timing of radiation therapy. Methods From January 2013 to May 2014, 90 patients with cervical cancer were diagnosed as pathologically diagnosed as stage IIb-Ⅲb in Guiyang Medical College Affiliated Tumor Hospital, with a median age of 51 years. Treatment options for neoadjuvant chemotherapy + concurrent chemoradiation. Neoadjuvant chemotherapy for TP regimen (paclitaxel + cisplatin or paclitaxel + lobaplatin chemotherapy) 2 cycles; synchronous chemotherapy with cisplatin or lobaplatin single; radiation therapy using pelvic IMRT and three-dimensional conformal brachytherapy . Chemotherapy before and after 2 cycles of chemotherapy and radiotherapy and chemotherapy were performed 5 days before radiotherapy and chemotherapy in the same period and radiotherapy and chemotherapy were started every 5 days during radiotherapy and chemotherapy in the same period. Radiotherapy and chemotherapy were completed in the same period and 10 days after radiotherapy and chemotherapy in the same period. DNA ploid analysis at 30 days after the end. DNA ploidy analysis using BD FACSCanto Ⅱ flow cytometry. Results The proportion of cells with high S phase in 2 cycles after neoadjuvant chemotherapy was significantly higher than that before neoadjuvant chemotherapy (42.0% vs 60.3%, P = 0.028, respectively) (P 0. 05). The proportion of cells with high S phase at 10-15 days after neoadjuvant chemotherapy was gradually decreased in 2 cycles, which was similar to that before neoadjuvant chemotherapy (P = 0.119). There was no significant difference between the two groups. The proportion of S-phase cells in radiotherapy to 30.6 Gy decreased slightly compared with those before neoadjuvant chemotherapy. The proportion of cells in high S phase after radiotherapy decreased further, which was significantly lower than that before neoadjuvant chemotherapy (P = 0.009) . Conclusion The existence of tumor cell redistribution after neoadjuvant chemotherapy in cervical cancer suggests that radiotherapy is best started 10 ~ 15 days after neoadjuvant chemotherapy. Understanding the cell cycle through DNA ploidy analysis can help guide the timing of radiation therapy and thus increase the efficacy of radiation therapy.